Natural history of left ventricular remodelling in aortic stenosis treated by surgery: Differences according to sex

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 13; no. 1; pp. 66 - 67
• Main Authors: Aghezzaf, S., Coisne, A.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.01.2021
• ISSN: 1878-6480
• DOI: 10.1016/j.acvdsp.2020.10.076

Many studies have shown differences between men and women regarding left ventricular remodelling in aortic stenosis with opposing results. Our aim is to see if women have a better preoperative and reverse remodelling in aortic stenosis. A comprehensive echocardiographic study of systolic, diastolic function and myocardial fibrosis was performed preoperatively, at 1 year and 3 years in patients undergoing surgical aortic valve replacement for aortic stenosis (±coronary artery bypass grafting). In total, 477 patients were included (200 women and 277 men). Women had a more concentric remodelling, a lower indexed left ventricular (LV) mass (103.7±29.9 vs. 115.9±29.3; P<0.001), a higher left ventricular ejection fraction (LVEF) (P=65% vs. 61%, P=0.01) and were more symptomatic at the time of surgery. One year after surgery (n=221, 95 women, 126 men), there was a regression in left ventricular mass (−23.5g/m2 in women, −18.0g/m2 in men), a better LVEF (+1.0 in women, +3.0 in men) and Global Longitudinal Strain. However, there was no statistically significative interaction of sex on the evolution of those parameters (for LV mass, interaction P=0.12). Three years after surgery (n=91, 42 women, 49 men), there was a tendency to an interaction of sex on the evolution of the LV mass. Indeed, the regression was higher among women (interaction P=0.066). It is of note that sex was independently associated in a multivariate model with LV mass reduction (expressed in percentage) (P=0.03). Despite a tendency, we have not showed any significant interaction of sex on the postoperative evolution of echocardiographic parameters regarding left ventricular remodelling in aortic stenosis treated by surgery. Nevertheless, sex was independently associated with LV mass reduction expressed in percentage.